CMS Delays Enforcement of Version 5010 for 3 Months

The Centers for Medicare and Medicaid Services (CMS) has delayed enforcement of Version 5010 transaction standards used for electronic health care claims for 90 days. January 1, 2012, remains the official deadline to adopt Version 5010. However, CMS will wait until March 31, 2012, to begin enforcing the new standards.

Implementation of Version 5010 is a prerequisite for using the updated ICD-10 CM diagnosis and ICD-10-PCS inpatient procedure code set in electronic health care transactions effective October 1, 2013. CMS' Office of E-Health Standards and Services (OESS) encourages all covered entities to work to become compliant with the new standards and to determine their readiness to accept the new standards as of January 1, 2012. While enforcement action will not be taken, OESS will accept complaints associated with compliance with Version 5010 transaction standards during the 90-day period beginning January 1, 2012. If requested by OESS, covered entities that are the subject of complaints must produce evidence of either compliance or a good faith effort to become compliant with the new standards during the 90-day period.

OESS is delaying the enforcement period based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012, compliance date, the number of submitters, the volume of transactions, and other testing data used as indicators of the industry’s readiness to comply with the new standards have been low across some industry sectors. OESS also has received reports that many covered entities are still awaiting software upgrades.